Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality

Abstract

Background: The purpose of this study was to compare the complications and mortality between bilateral simultaneous total knee arthroplasty (BTKA-Simultaneous) and bilateral staged TKA (BTK-Staged) while adjusting for differences in patient, surgeon, and hospital characteristics.

Methods: An integrated health care system total joint registry was used to compare patients undergoing BTKA-Simultaneous to BTKA-Staged. For outcomes related to revision and infection, the sample included 11,118 patients, and for outcomes of death, acute myocardial infarction, stroke, and venous thromboembolism, a subsample of 7991 patients with comorbidity data was selected.

Results: Overall death and complications in both groups were rare. The complication rates for BTKA-Simultaneous and BTKA-Staged were comparable: aseptic revision (1.17% vs 0.9%), septic revision/deep infection (0.8% vs 0.7%), death (0.28% vs 0.1%), and adverse events (2.49% vs 1.97%). In the adjusted models, there were no significant differences in any of the outcomes between the 2 groups.

Conclusion: There is a lack of evidence to support superiority of either BTKA-Simultaneous or BTKA-Staged.

Keywords: bilateral; complications; propensity score; simultaneous; staged; total knee arthroplasty.